颈胸交界区感染、积气性病变MDCT表现特征及其解剖、病理学基础

目的：明确颈胸交界区感染、积气病变的MDCT影像表现特点和规律，结合尸体断面解剖观察，探讨其影像学表现与解剖、病理学基础的相关性。方法：观察尸体断面标本11具（5例横断面、4例矢状面和2例冠状面），主要观察颈胸交界区组织结构的位置、形态特征，并结合经临床或病理证实的颈胸交界区感染、积气性病变84例的MDCT表现特点及规律，阐明影像学表现与解剖、病理学的相关性。结果：ll例尸体断面解剖发现：咽后间隙、椎前间隙与上纵隔食管后间隙自然相通；椎前间隙向外下方经腋鞘与腋窝相连通；颈动脉鞘向下与上纵隔血管周围间隙相延续；颈部气管前间隙向下与上纵隔相通。84例患者的MDCT影像表现：咽后间隙感染可向下达后纵隔；椎前间隙感染可向下蔓延至后纵隔，向两侧蔓延至腋窝；颈动脉鞘感染可向下延伸至上纵隔；积气性病变可同时分布于纵隔、颈部、腋窝区。结论：MDCT能够详细反映颈胸交界区感染、积气病变的局部表现和向周围扩散的情况；尸体断面发现的解剖特点决定了此区域病灶的优势分布．

Multi-detector CT features and anatomic and pathological basis of infection and air collection in cervico-thoracic juntion

Objective：To study the multi-detector CT （MDCT） appearances of infection and air collection at cervico- thoracic junction,and correlated with anatomic findings on cross-section of cadavers. Methods： 11 adult cadavers were used to study the structure and morphology characteristics of cervico-thoracic junction, with axial section （n=5）, sagittal section （n=4） and coronal section （n=2）. 84 patients with infection or air collection （pneumatosis） at cervico-thoracic junction un derwent MDCT were also studied and correlation with patho-anatomy was performed. Results：The main findings of 11 cada- vers were as follows=anatomic communication was revealed between retropharyngeal space and prevertebral space with ret- roesophageal space of superior mediastinum; prevertebral space extended laterally and inferiorly, communicating with axilla ry fossa via axillary sheath; carotid sheath was continuous with perivascular space of superior mediastinum; pretracheal space of neck communicated with superior mediastinum. The MDCT findings of 84 cases showed infection of retropharyn- geal space extended downward to posterior mediastinum; infection of prevertebral space extended downward to posterior mediastinum and laterally to axillary fossa;infection of carotid sheath could spread downward to superior mediastinum. Air collection in mediastinum in cases of pneumatosis could simultaneously spread to neck and axillary fossa. Conclusion ： The de- tail information of distribution of infection or air collection in cervico-thoracic junction could be revealed clearly on MDCT. The distribution of disease depends on the specific anatomy characteristics which were showed on cross section study of ca- davers.